中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
17期
2003-2007
,共5页
宋向奇%陈通%付爱军%朱军%李建民%金玉兰%王瑞刚%肖增兵
宋嚮奇%陳通%付愛軍%硃軍%李建民%金玉蘭%王瑞剛%肖增兵
송향기%진통%부애군%주군%리건민%금옥란%왕서강%초증병
低温,人工%颅脑损伤%颅内压%Meta 分析
低溫,人工%顱腦損傷%顱內壓%Meta 分析
저온,인공%로뇌손상%로내압%Meta 분석
Hypothermia,induced%Craniocerebral trauma%Intracranial pressure%Meta - analysis
目的:分析亚低温治疗时间对重型颅脑损伤患者预后和颅内压的影响,寻找亚低温治疗后的最佳复温时机。方法全面检索 Cochrane 协作网、PubMed、EMBase、中国生物医学文献数据库( CBM)、CNKI 数据库、万方数据库、维普数据库2013-07-12之前发表的文献。依据 Cochrane Reviewer Handbook 5.2对纳入文献的质量进行评估,提取数据后采用 RevMan 5.2软件进行 Meta 分析。结果共8篇文献纳入 Meta 分析,结果显示,亚低温组病死率低于常温组〔RR =0.75,95% CI(0.60,0.93),P =0.007〕;亚组分析显示,在病死率方面亚低温持续3~5 d 亚组与亚低温持续至颅内压正常亚组均低于常温组(RR 值分别为0.68和0.65)。在预后〔格拉斯哥预后评分(GOS 评分)4~5分〕方面,亚低温组的预后好于常温组〔RR =1.32,95% CI(1.11,1.57),P =0.002〕;亚组分析:亚低温持续72 h 亚组〔RR =1.76,95% CI(1.23,2.52),P =0.002〕、持续3~5 d 亚组〔 RR =1.41,95% CI(1.09,1.82),P =0.009〕、持续至颅内压正常亚组〔RR =1.41,95% CI(1.15,1.73),P =0.0010〕预后均好于常温组。结论亚低温治疗的最佳复温时机有可能在伤后第5天前后,但其尚需更多高质量的临床研究进一步验证。
目的:分析亞低溫治療時間對重型顱腦損傷患者預後和顱內壓的影響,尋找亞低溫治療後的最佳複溫時機。方法全麵檢索 Cochrane 協作網、PubMed、EMBase、中國生物醫學文獻數據庫( CBM)、CNKI 數據庫、萬方數據庫、維普數據庫2013-07-12之前髮錶的文獻。依據 Cochrane Reviewer Handbook 5.2對納入文獻的質量進行評估,提取數據後採用 RevMan 5.2軟件進行 Meta 分析。結果共8篇文獻納入 Meta 分析,結果顯示,亞低溫組病死率低于常溫組〔RR =0.75,95% CI(0.60,0.93),P =0.007〕;亞組分析顯示,在病死率方麵亞低溫持續3~5 d 亞組與亞低溫持續至顱內壓正常亞組均低于常溫組(RR 值分彆為0.68和0.65)。在預後〔格拉斯哥預後評分(GOS 評分)4~5分〕方麵,亞低溫組的預後好于常溫組〔RR =1.32,95% CI(1.11,1.57),P =0.002〕;亞組分析:亞低溫持續72 h 亞組〔RR =1.76,95% CI(1.23,2.52),P =0.002〕、持續3~5 d 亞組〔 RR =1.41,95% CI(1.09,1.82),P =0.009〕、持續至顱內壓正常亞組〔RR =1.41,95% CI(1.15,1.73),P =0.0010〕預後均好于常溫組。結論亞低溫治療的最佳複溫時機有可能在傷後第5天前後,但其尚需更多高質量的臨床研究進一步驗證。
목적:분석아저온치료시간대중형로뇌손상환자예후화로내압적영향,심조아저온치료후적최가복온시궤。방법전면검색 Cochrane 협작망、PubMed、EMBase、중국생물의학문헌수거고( CBM)、CNKI 수거고、만방수거고、유보수거고2013-07-12지전발표적문헌。의거 Cochrane Reviewer Handbook 5.2대납입문헌적질량진행평고,제취수거후채용 RevMan 5.2연건진행 Meta 분석。결과공8편문헌납입 Meta 분석,결과현시,아저온조병사솔저우상온조〔RR =0.75,95% CI(0.60,0.93),P =0.007〕;아조분석현시,재병사솔방면아저온지속3~5 d 아조여아저온지속지로내압정상아조균저우상온조(RR 치분별위0.68화0.65)。재예후〔격랍사가예후평분(GOS 평분)4~5분〕방면,아저온조적예후호우상온조〔RR =1.32,95% CI(1.11,1.57),P =0.002〕;아조분석:아저온지속72 h 아조〔RR =1.76,95% CI(1.23,2.52),P =0.002〕、지속3~5 d 아조〔 RR =1.41,95% CI(1.09,1.82),P =0.009〕、지속지로내압정상아조〔RR =1.41,95% CI(1.15,1.73),P =0.0010〕예후균호우상온조。결론아저온치료적최가복온시궤유가능재상후제5천전후,단기상수경다고질량적림상연구진일보험증。
Objective To analyze the effects of mild hypothermia therapy(MHT)time on the prognosis and intracra-nial pressure(IP)in patients with severe craniocerebral injuries,to find the best rewarming time after MHT. Methods The Cochrane,PubMed,EMBase,CBM,CNKI,Wangfang Data,VIP database were searched for relevant information and evalua-ted the quality of the enrolled literatures according to Cochrane Reviewer Handbook 5. 2. RevMan 5. 2 software was used to do meta - analysis on the extracted data. Results A total of eight literatures were included in this Meta - anlysis. The mortality rate was lower in MHT group than in normal temperature(NT)group〔RR = 0. 75,95% CI(0. 60,0. 93),P = 0. 007〕. By subgroup analysis,mortality was lower in subgroups 3 ~ 5 d - MHT and MHT - till - normal - IP than in NT group(RR = 0. 68, 0. 65). The prognosis was better in MHT group than in NT group〔RR = 1. 32,95% CI(1. 11,1. 57),P = 0. 002〕. By sub-group analysis,prognosis was better in subgroups 72 h - MHT〔RR = 1. 76,95% CI(1. 23,2. 52),P = 0. 002〕,3 ~ 5 d -MHT〔RR = 1. 41,95% CI(1. 09,1. 82),P = 0. 009〕,MHT - till - normal - IP〔RR = 1. 41,95% CI(1. 15,1. 73),P= 0. 0010〕than in NT group. Conclusion The best MHT rewarming time may be on the 5th day,which needs more high -quality clinical studies for further validation.